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' LAND USE PERMIT APPLICATION - Burnett County, WI <br />Applicant Complete All Sections Below This Line <br />Permit Types and Fees: (Please, check appropriate boxes) <br />Dwelling/Principal Structure <br />$300 <br />Addition/Alteration to Dwelling/Principal Structure <br />$200 <br />Commercial/Industrial Structure <br />$300 <br />Addition/Alteration to Commercial/Industrial Structure <br />$200 <br />Accessory Structure (Garage, Shed, etc.) <br />$150 <br />Addition/Alteration to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) <br />$200 <br />Addition/Alteration to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk <br />Bunkhouse <br />$250 <br />WI State Statute 59.692(1v) Structures <br />$350 <br />Driveways/ & Campground Structures <br />$125 <br />Filling/Grading <br />$150 <br />Boathouse <br />$500 <br />1$100 <br />Six Month Camping Unit (One Per Year) <br />$100 <br />Permit Extension (1Year Extension -Allowed Once) <br />*NOTE: After -the -fact permits (permit aquired after construction has begun) may cost up to three times the normal fee. <br />*Communication Towers & Signs require a different application form; see corresponding application, and fees. <br />*Items not listed above will be treated as accessory structures, such as: pergolas, landscaping, etc. <br />Property Owner's Name: 1 0141 N I G <br />Property Owner's Mailing Address: t U A 1- t�.�) �• LN i/� `'�� �f j <br />City State Zip <br />Property Site Address: <br />Contact's Telephone Number-3 <br />,�'� <br />Contact's Email: IN41 l t 5 'a bj A,0e P,0t4 t t4 . eD M <br />Legal Description of Property: V i L.LG r ®C je j(pW �— A a L o T" ri T3L V Ho <br />Section #: 2-0 Town #:--r4b N Range #: \L' W Town of: 04/1L.4W P <br />*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br />Tax ID # (1-5 digit number; found on tax statement): \ 5Z z <br />Proposed Use of Structure/ ddition: Czy a Ad rg <br />Anticipated Start Date: �tA IQ Z-0 ( (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor -TOk L-AW50nl Sewer Installer: <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO[ ALL CONDITIONS LISTED BELOW: <br />ND �7v 6 e, U S a �/^ A U,IM, u ✓l A -i 4 I ,/ Q 74D/1 . <br />Al a Ta a fP/y 1,;r 4 y <br />Date of staff site visit: / Initials of site visit staff: " <br />APPROVED BY LAND SERVICES OFFICIAL: ' -DATE: (D S l <br />UPON APPROVAL: APPLICANT MUST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Transcendent: - Page 1 of 4 <br />Laserfische: - Burnett County, WI Land Use Application — Rev 1/2019 <br />Irl <br />w <br />5 <br />0 <br />y <br />v <br />m <br />0 <br />r <br />0 <br />r <br />0 <br />Al <br />ra.. <br />S <br />Fee Rec: <br />Check #: <br />rV <br />07-- <br />